S2W3: Roles & Rolls

Role of the physiotherapist - what do we actually do?

Physiotherapists play an important role in the health care team and wider health service umbrella. As primary practitioners (like doctors) we are able to assess, diagnose and treat ailments within our scope of practice. The scope of the physio is very large, from musculoskeletal, neuro to cardiopulmonary and other disorders (like renal) where management of their condition partially comes in the form of exercise, movement strategies etc. Often the scope of practice of a health care provider overlaps with the that of other health care providers. As a consumer of health services, you should decide to what extent you trust the clinicians educational basis for treatment... for example, if a soft tissue therapist told me they were altering my muscle "cell memory", I would be very suspicious! I will list and describe different health care providers briefly (hopefully without undermining their health profession). We haven't had a lecture on this as of yet, but this is my current understanding.

• Doctors/physicians. In western society, Drs lead the health care team. Although autonomous, physiotherapists must refer back to the doctor in some circumstances such as suspected cancer, ordering X-ray imaging and when we think medication may be beneficial. Drs usually refer to physiotherapists for diagnosing physical ailments like sprained ankles, and then physios may refer the client back to the Dr or a specialist (orthopaedic surgeon) if we suspect surgery is necessary. Doctors don't usually offer exercise prescription or physical rehabilitation, rather they use pharmacological agents to interact with biological processes to improve health outcomes.
• Occupational Therapists. OT's are all about functioning at home and in the community. They assess and initiate the modification of living areas or teach clients to move more effectively in certain environments or with aiding instruments/tools (such as transferring). Some common ground include prescribing ambulation aids and using hoists. If physio's can teach client's to move, OTs will teach them to dance! OT's also are trained to test some neurological disorders, similar to physiotherapists.
• Chiropractors seem to come in two flavours; traditional/philosophical and biomedical. Physiotherapists and chiropractors have slightly different histories/philosophies but are both trained to manage musculoskeletal conditions. I believe the biomedical orientated variety have become similar to physiotherapists over time. Chiropractors are spine adjustment specialists but also work on soft tissues and other joints. Physiotherapists are very exercise/function orientated with techniques to manipulate the spine and techniques to mobilise joints and soft tissue. Physiotherapists, with further training, may practice acupuncture (this may be considered alternative medicine) whilst chiros have their own alternative methods/tools.
• Osteopaths use manual therapy and mobilisation techniques like physios and chiros do. Historically, chiropractic roots lie with osteopathic practice. All three professions, in the musculoskeletal realm, claim to offer similar treatment outcomes and a holistic approach. Of the three, osteopathic medicine is the one I have the least knowledge about. In New Zealand it is not uncommon to hear health professionals refer to osteopaths as 'Gypsies' - but we certainly do respect their practice.
• Acupuncturist. As the name suggests, they practice either western or eastern acupuncture medicine. 
• Psychologist. We are taught some psychological techniques for motivation, managing stress and anxiety. Physios only manage mental health issues when they co-present with physical rehabilitation or training. Physios consult with psychologists on delicate situations and often refer the client to psychologists or counsellors when it is believed to be in the best interest of the client.
• Podiatrist. Lower limbs and feet can be considered to be the foundation of our postural health (did you see what I done there?!) Physiotherapists and podiatrists can prescribe splints and wedges to adjust the position of any lower limb joint. Podiatrists specialise in the care of leg and foot; from clinical biomechanics (with prescription of a certain shoe/insole) to the care of the skin (managing corns and calluses - this is something physiotherapists don't primarily manage).
• Soft tissue therapist (massage therapist). Physios know how to massage, the principles, contraindications etc. Our focus is on therapeutic effect and our understanding of the body as an integration of multiple systems allows us to work with wider scope than that of a massage therapist. Massage therapists can often specialise in a style of massage (like Thai massage) - this is something physiotherapists don't usually consider being trained in. We apply the necessary strokes/techniques to impact physiological and psychological parameters. Some massage therapists are more 'in tune' with soft tissue than physios due to their specific discipline and hands on patient contact. Both physios and massage therapists learn about trigger points and soft tissue manipulation.
• Personal and high performance trainers. Physiotherapists know a lot about exercise and health, much more than a personal trainer. Physios know about high performance too, but generally leave that to specialised trainers who have industry knowledge and can better apply training principles for specific peak performance. However, injury prevention and rehabilitation falls almost exclusively within the scope of a physiotherapy or in collaboration between both parties.
• Speech language therapist. Physiotherapists recognise the neurological and physical aspects of speech disorders like a speech language therapist. We can help the client with TMJ pain and problem joint kinematics. However physios leave sound articulation and mastication training to the speech language therapist.
• Paramedic. Paramedics provide first aid. Physios don't attend to first aid incidents in the community (unless physios are already on-site and basic first aid can be given) but generally work in a similar capacity in a sporting context.
• Sport Medic, Sports Paramedic, Sports Physio & Sports Doctor. This is the medical team that attends major sport functions. There may be a nurse amongst the team too. Sport medics apply basic first aid, strapping, massage and are the support hands to any other health professional in the team. Sports paramedics are qualified to complete any emergency medicine but most of the time they will be suturing up lacerations and possibly even relocating subluxed joints. Sports physiotherapists are experts on strapping, massage, therapeutic exercise and return to play. Sport/team doctors are the leaders of the health care team.

Some people roll with their pants (most commonly jeans) halfway down their bottom when they walk. ["Roll" =  it's their style]. According to our anatomy lecturer, people who do this are in danger of compressing their lateral cutaneous nerve of the thigh (also the risk of their pants slipping off their bottom). If they feel pins and needles on the lateral aspect of their thigh, our treatment plan would start with them pulling their pants up!! (A walking/transfer belt would not be suitable).

Foam rolls in hydrotherapy are called 'noodles' and they can be used to stop us from rolling (rotating in the water) by increasing the radius about our longitudinal axis.  Other rolls in the pool were rolls of adipose tissue - especially mine! I rationalise this as a mechanism for insulation (but I should look at adapting my physical composition in preparation for summer!) This was our last week of hydrotherapy. It finished with an assessment where we were given a case study and had to integrate principles of hydrotherapy into a rehabilitation plan. Our case was a 35 year old female tennis player with rotator cuff tendinitis - we were given more details than this though.

Foam rolls are like 'noodles' (only more solid) and are used on land to massage / stretch our IT-band (amongst other muscles e.g. gluteus muscles). Those who haven't used it regularly will think it is slightly tortuous! It is particularly good for an athletic population because tissues need to be stretched and often stretching won't have the same effect as IT-band rolling. Other rolling strategies that are effective are to use a tennis ball under the sole of the barefoot, apply some weight to the ball and roll out the plantar fascia. Give it a go when you have the opportunity!

At the beginning of this week I was busy using a toilet roll / paper as tissues! Yep. I had another cold. Thankfully it is on its way out. I'm actually surprised about how many 'rolls' I managed to talk about! There are other rolls which I may cover in future weeks e.g. Lumbar rolls to support the lumbar spine lordotic curvature and the Million Dollar Roll which is a lumbar vertebrae manipulation technique.

Many of the lecturers, especially lab and clinical placement staff for 254 and 255, are wonderful role models! They bring wisdom and passion to the field of physiotherapy. It is truly inspirational for us students to observe and interact with them. I have mentioned this before (with one lab demonstrator learning all of our names), but now that the year has progressed it is clear that most of the lecturers want to help us achieve a high level of practice. Not only this, but they treat each student as individuals and interact with us on a semi-personal level.

PHTY254 Neuro required the class to assess a few neurological conditions, such as multiple sclerosis and stroke patients, rolling from a lying position onto their side (side lying) then into a sitting position. This was part of the objective assessment. Our aim is to make everyday tasks easier by providing strategies to move, increasing their strength and mobility. This is the last week of Umove for me this year. Next week I begin my second placement!

We have an electronic resource for tests of the upper and lower limb (previous years were able to purchase a DVD - so I borrowed it because our internet is slow!)

I've found some more vids!! Have a good weekend!